Ikääntyneiden kaltoinkohtelu ja heidän hoitonsa laiminlyöminen on globaali ongelma, joka on huolestuttavasti lisääntynyt viime vuosina. Tämän tutkimuksen tarkoituksena oli kuvata sairaalan ulkopuolisen ensihoidon työntekijöiden kokemuksia ikääntyneiden kaltoinkohtelun ilmenemisestä. Tavoitteena oli tuottaa tietoa kaltoinkohdeltujen ikääntyneiden hoitotyön kehittämiseksi. Tutkimusaineisto kerättiin Webropol-kyselynä yhden sairaanhoitopiirin ensihoitajilta sekä Suomen Ensihoitoalan Liiton kautta Suomessa toimivilta ensihoitoalan ammattilaisilta 1.11.2019–29.2.2020. Tutkimuskyselyyn osallistui 200 henkilöä. Kvalitatiivinen tutkimusaineisto analysoitiin induktiivisella sisällönanalyysillä ja kvantitatiivinen tutkimusaineisto SPSS for Windows 22 -ohjelmalla. Yli puolet (56 %) vastaajista oli kohdannut melko tai erittäin paljon ikääntyneiden kaltoinkohtelua ensihoitotehtävien yhteydessä. Ikääntyneiden kaltoinkohtelu ilmenee tutkimustulosten mukaan monimuotoisena. Ensihoitajien tunnistama ikääntyneiden kaltoinkohtelu on psykososiaalista, fyysistä, taloudellista ja teknologista. Lisäksi se ilmenee laiminlyönteinä perustarpeiden ja asumisolosuhteiden huomioimisessa sekä voinnin seuraamisessa ja sairauksien hoidossa. Kaltoinkohtelijana tai hoidon ja huolenpidon laiminlyöjänä on joko iäkkään ihmisen läheinen, usein omaishoitaja tai muu perheenjäsen, tai kotihoidon tai kotisairaanhoidon ammattilainen. Experiences of elder abuse in out-of-hospital emergency care Elder abuse and neglect are a global problem, which has increased alarmingly in recent years. The purpose of this study was to describe out-of-hospital emergency care providers’ experiences of elder abuse identification and forms of abuse, and the aim was to produce knowledge that can be used to develop care services for abused older people. The research data were generated between 1 January 2019 and 29 February 2020 with emergency care providers of one hospital district and with members of the Finnish Association of Paramedics and A & E Nursing Professionals across Finland using the Webropol survey tool. The study involved 200 participants. Qualitative data were analysed by inductive content analysis, while quantitative data were analysed using SPSS for Windows 22. More than half (56%) of the emergency care providers had encountered rather much or very much elder abuse in the context of emergency responses. According to the results, they had witnessed various forms of elder abuse. The abuse identified by the emergency care providers included psychosocial, physical, economic, and technological abuse. In addition, it involved neglecting the older people’s basic needs, and failing to attend to their living conditions, to observe their condition, and to care for their illnesses. The abuse and neglect of care and nursing needs was carried out by either persons close to the old person, often a family caregiver or other family member, or by home care or home nursing professionals.

This qualitative study describes out-of-hospital emergency care providers’ experiences and views of situational awareness (SA) in the identification of abuse, including observations that led them to suspect abuse. Nine prehospital emergency care providers and three community paramedics were interviewed based on preselected themes. The data was analyzed using inductive content analysis. According to the results, emergency care providers’ self-defined situational awareness consisted of cognitive competence (logical reasoning and detection of cause-effect relationships); emotional competence (empathy and emotional intelligence); social competence (interaction skills and assessment of family dynamics), and experiential knowledge. Indicators of abuse involved the overall situation; the client’s physical condition; the client’s mental condition; the context and circumstances, and the logic in client reports. Although situational awareness develops with work experience, it is advisable for educators to include a wide range of cognitive, emotional and social skills in the initial and continuing education of emergency care professionals. These skills can be practiced using multi-professional simulation-based education.

No abstract

Background and purposeElder abuse, neglect, and exploitation are under-detected and under-reported. The purpose of this qualitative study was to describe out-ofhospital emergency care providers' experiences of identifying elder abuse.MethodsIndividual theme interviews were conducted with nine prehospital emergency care providers and three community paramedics in spring 2019. The transcribed data were analyzed using inductive content analysis.ResultsAlthough the short duration of care contacts made the identification of elder abuse challenging, the emergency care providers detected indicators of physical, psychological and social abuse, unethical action, material exploitation, and self-neglect/self-abuse. The professionals based their observations on patient and family interviews, on clues in the home environment, on caregiving quality combined with the patient's medical history, and on physical signs, which were the easiest to identify.Implications for PracticeThe identification of elder abuse may be improved by multiprofessional collaboration, by increased attention given to risk groups and common indicators of abuse, and by adoption or creation of screening tools to assist detection and reporting. Training on the detection of elder abuse should be included in nursing and social work curricula and in the continuing professional development of emergency care providers.